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Nevin Manimala Statistics

District-level epidemiology, hot spots and sociodemographic determinants of tobacco use in Indian men and women: analysis of national family health survey-4 (2015-16)

Public Health. 2021 Apr 19;194:127-134. doi: 10.1016/j.puhe.2021.03.001. Online ahead of print.

ABSTRACT

OBJECTIVES: To map district-level tobacco hot spots and understand the Sociodemographic Indices (SDI) influencing tobacco consumption in Indian men and women.

STUDY DESIGN: Cross-sectional study.

METHODS: Tobacco use data from 640 districts of India were extracted from National Family Health Survey-4, carried out from 2015 to 2016 with a sample size of 103,411 men and 699,686 women. Geographic Information System was used to map the tobacco prevalence, and hot spots were identified by spatial statistics (Getis-OrdGi∗). SDI were studied by bivariate analyses and binary logistic regression.

RESULTS: India has two major tobacco hot spots; one comprising the districts of North-Eastern states, excluding Sikkim, and the second cluster is formed by the districts of Central-Eastern states. These hot spots coincide well with demographic determinants: North-East (adjusted odds ratio [aOR] men, 5.74; aOR women, 13.54) and Central India (aOR men, 4.5; aOR women, 3.5) have higher odds of Tobacco consumption. In men, respondents with no education (aOR 2.52; 95% confidence interval [CI]: 2.26-2.81) and Muslims (aOR 3.53; 95% CI: 2.93-4.26) have higher odds of tobacco consumption. The poorest (men aOR, 2.06; 95% CI: 1.87-2.27; women aOR, 3.36: 95% CI: 2.69-4.19) and ST women (aOR 1.89; 95% CI: 1.68-2.13) have higher odds of tobacco consumption.

CONCLUSIONS: We have identified tobacco hot spots and detailed the SDI affecting tobacco use separately in men and women to guide public health policies for targeted intervention of tobacco consumption.

PMID:33887600 | DOI:10.1016/j.puhe.2021.03.001

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Nevin Manimala Statistics

The clinical and prognostic role of ALK in glioblastoma

Pathol Res Pract. 2021 Apr 15;221:153447. doi: 10.1016/j.prp.2021.153447. Online ahead of print.

ABSTRACT

BACKGROUND: anaplastic lymphoma kinase (ALK) overexpression and gene alterations have been detected in several malignancies, with prognostic and therapeutic implications. However, few studies investigated the correlation between ALK altered expression and prognosis in patients with glioblastoma (GBM).

METHODS: We performed an evaluation of ALK overexpression and structural/quantitative chromosome alterations through immune-histochemical assay (IHC with D5F3 antibody) and fluorescent in situ hybridization (FISH) in patients with isocitrate dehydrogenase (IDH) wild type (wt) GBM. Assuming an ALK overexpression in 20 % of patients we planned a sample of 44 patients to achieve a probability of 90 % to include from 10 % to 30 % of patients with ALK alterations.

RESULTS: We evaluated 44 patients with IDH wt GBM, treated in our institution and dead due to GBM progression in 2017. ALK overexpression obtained by a composed score (the product of IHC intensity staining and rate of positive cells) was observed in 19 (43 %) patients. FISH analysis showed that 11 patients (25 %) had gene deletion, 2 patients (4.5 %) had monosomy and one patient (2.3 %) presented polysomy. Only one patient (2.3 %) demonstrated ALK rearrangement. There was no statistical difference in median OS between patients with ALK-positive (mOS = 18.9 months) and ALK-negative IHC (mOS = 18.0 months).

CONCLUSION: We identified some rare previously unreported alterations of ALK gene in patients with IDH wt GBM. In these patients, the ALK overexpression does not influences survival.

PMID:33887544 | DOI:10.1016/j.prp.2021.153447

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Nevin Manimala Statistics

The association of breast cancer-related lymphedema after unilateral mastectomy with shoulder girdle kinematics and upper extremity function

J Biomech. 2021 Apr 11;121:110432. doi: 10.1016/j.jbiomech.2021.110432. Online ahead of print.

ABSTRACT

The purpose of this study was to examine the association of breast cancer-related lymphedema on shoulder girdle kinematics and upper extremity function. The study included 67 breast cancer survivors with and without unilateral lymphedema. Individuals were divided into non-lymphedema, moderate and severe lymphedema groups according to the volumetric measurement difference between the affected and unaffected upper extremities. A three-dimensional motion monitor-electromagnetic system was used to analyze scapular movements during the elevation and depression phases of the upper extremity elevation in the scapular plane. Shoulder range of motion was assessed with a digital inclinometer. Upper extremity function was assessed with the ‘Disabilities of the Arm, Shoulder, and Hand Questionnaire-Short Form (Quick-DASH)’. The scapular upward rotation was lower for the severe lymphedema group than for the non-lymphedema group in the 90-60-30° depression phases of arm elevation (p < .05). The scapular anterior tilt was higher for the severe lymphedema group than for the non-lymphedema group in the 30° depression phase of arm elevation (p < .05). Shoulder abduction range of motion was the lowest in the severe lymphedema group (p < .05). The non-lymphedema group had the lowest quick-DASH score and the severe lymphedema group had the highest score (p < .05). There were statistically significant moderate associations between the quick-DASH scores and scapular movements in all groups (p < .05). The development, presence and/or severity of lymphedema were associated with impaired shoulder-girdle kinematics and decreased upper extremity function. However, a need exists for longitudinal studies comparing individuals with and without lymphedema and healthy controls.

PMID:33887538 | DOI:10.1016/j.jbiomech.2021.110432

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Nevin Manimala Statistics

The clinical effect of early enteral nutrition in liver-transplanted patients: a systematic review and meta-analysis

Clin Res Hepatol Gastroenterol. 2021 Apr 19;45(3):101594. doi: 10.1016/j.clinre.2020.101594. Online ahead of print.

ABSTRACT

BACKGROUND: Appropriate nutritional support is critical for patients undergoing liver transplantation (LT). Early enteral nutrition (EEN) has been considered effective in critically ill patients. However, the clinical effect of EEN on liver-transplanted patients is unclear.

AIM: To evaluate the clinical effect of early enteral nutrition in patients receiving a liver transplant.

METHODS: A systematic search was performed on the Cochrane Library, PubMed, CINAHL, EMBASE, Web of Science, WanFang database, Chinese Biomedical Literature Database and China National Knowledge Infrastructure to collect relevant studies up to January, 2020. The results of these studies were pooled to calculate relative risk and mean differences with 95% confidence intervals for dichotomous data and continuous data. All statistical analysis was carried out by Review Manager 5.3.

RESULTS: 9 RCTs and 10 cohort studies with 1300 patients were included in this meta-analysis. Compared with TPN, EEN reduced postoperative infection rates, ICU hours, length of hospitalization, and the duration of bowel ventilation as well as strengthening the nutritional status and liver function of LT patients. There is no difference in mortality rates, blood glucose levels or gastrointestinal complications. Compared to TPN, the combined EN + PN method more effectively prevented infection.

CONCLUSION: For patients undergoing liver transplantation, early enteral nutrition with or without combination may considered as a better nutritional therapy than total parenteral nutrition.

PMID:33887541 | DOI:10.1016/j.clinre.2020.101594

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Nevin Manimala Statistics

Nalbuphine for spinal anesthesia : A Systematic Review and meta-analysis

Pain Pract. 2021 Apr 22. doi: 10.1111/papr.13021. Online ahead of print.

ABSTRACT

PURPOSE: Various adjuvants for prolongation of intraoperative and postoperative analgesia have been clinically studied, but the safety and efficiency of nalbuphine as an adjuvant to local anesthetics in spinal anesthesia remains unconfirmed. Therefore, we conducted a meta-analysis about the effect of nalbuphine as an adjuvant to local anesthetics in spinal anesthesia in regard to time of onset of sensory blockade and motor blockade,duration of motor blockade, two-segment sensory regression time, the duration of analgesia, and incidence of side effects to provide a reliable basis for clinical application.

METHODS: Databases including PubMed, Cochrane, EMBASE, Web of Science, CNKI, CBM, WanFang database and Viper database were searched for eligible studies. Data was extracted according to the proposed inclusion and exclusion criteria, RevMan 5.3 and Stata16 were selected to perform meta-analysis.

RESULTS: Eighteen published studies including 1633 patients met the inclusion criteria. The results showed that adding nalbuphine to local anesthetics for spinal anesthesia can prolong two-segment sensory regression time [MD=24.31; 95% CI 19.61~29.00, P < 0.001] and the duration of analgesia [(MD =118.11;95%CI 71.34 ~ 164.89, P < 0.001]without significantly increasing the incidence of adverse reactions in comparison to normal saline group. What’s more, the analgesic effect of nalbuphine group was not statistically different from that of control group when compared with the potent opioid group, but the occurrence of hypotension(RR = 0.35, 95% CI: 0.18-0.68, P<0.01), the occurrence of shivering(RR = 0.19, 95% CI: 0.08-0.43, P<0.01)and the occurrence of pruritus (RR = 0.23, 95% CI: 0.10-0.53, P<0.01) was lower than the potent opioid group.

CONCLUSIONS: Nalbuphine as additives to local anesthetics can significantly prolong the two segments of sensory block and the average duration of analgesia without increasing the incidence of adverse reactions when compared with normal saline group. And the analgesic efficacy of nalbuphine served as an adjunct to local anaesthetics was clinically not different from that of the potent opioids, but the occurrence of hypotension, shivering and pruritus was lower than the potent opioids.

PMID:33887111 | DOI:10.1111/papr.13021

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Nevin Manimala Statistics

Effects of Implementing an Interactive Substance Use Disorders Workshop on a Family Medicine Clerkship

Fam Med. 2021 Apr;53(4):295-299. doi: 10.22454/FamMed.2021.399314.

ABSTRACT

BACKGROUND AND OBJECTIVES: Substance use disorders (SUD) remain a public health crisis and training has been insufficient to provide the skills necessary to combat this crisis. We aimed to create and study an interactive, destigmatizing, skills-based workshop for medical students to evaluate if this changes students’ self-reported knowledge, skills, and attitudes toward patients with SUD.

METHODS: We surveyed students on a required family medicine outpatient rotation at a Pacific Northwest medical school during clerkship orientation on their views regarding SUDs utilizing the validated Drug and Drug Problems Perceptions Questionnaire containing a 7-point Likert scale. After attending a substance use disorder workshop, they repeated the survey. We calculated differences between the paired pre- to postsurveys.

RESULTS: We collected the pre- and postdata for 118 students who attended the workshop and showed statistically significant positive differences on all items.

CONCLUSIONS: The positive change in the medical students’ reported attitudes suggests both necessity and feasibility in teaching SUD skills in a destigmatizing way in medical training. Positive changes also suggest a role of exposing students to family medicine and/or primary care as a strategy to learn competent care for patients with substance use disorders.

PMID:33887053 | DOI:10.22454/FamMed.2021.399314

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Nevin Manimala Statistics

The role of hemogram parameters and CRP in predicting mortality in COVID-19 infection

Int J Clin Pract. 2021 Apr 22:e14256. doi: 10.1111/ijcp.14256. Online ahead of print.

ABSTRACT

AIM: This study aimed to investigate hemogram parameters and CRP that can be used in clinical practice to predict mortality in hospitalized patients with a diagnosis of COVID-19.

METHODS: This cohort study was conducted at University Hospital, which is a designated hospital for COVID-19 patients. Adult patients who were admitted to our hospital emergency department with suspected COVID-19 and who were hospitalized in our institution with a COVID-19 diagnosis were analysed.

RESULTS: There were 148 patients hospitalized with COVID-19. All-cause mortality of follow-up was 12.8%. There were statistically significant results between the 2 groups (survivors and non-survivors), which were classified based on hospital mortality rates, in terms of the lymphocyte to C-reactive protein ratio (LCRP), Systemic immune inflammation index (SII), , neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), CRP concentration and comorbid disease. In a Receiver operating characteristic (ROC)”. curve analysis, LCRP, NLR, PLR, and SII area under the curve (AUC) for in-hospital mortality were 0.817, 0.816, 0.733 and, 0,742 respectively. Based on an LCRP value of 1 for in-hospital mortality, the sensitivity, and specificity rates were 100%, 86.8% respectively. Based on the average SII of 2699 for in-hospital mortality, the sensitivity, specificity, and accuracy rates were 68,4%, 77,5%, and 76,3%, respectively A total of 19 patients died during hospitalization. All of these patients had an LCRP level ≤ 1; 14 had an NLR level ≤ 10.8; 13 had a SII ≥ 2699 (Fisher’s exact test, p = 0.000). Independent predictors of in-hospital mortality rates were LCRP < 1, PLR, SII ≥ 2699, white blood cell count, CRP, age, comorbidities, and ICU stay.

CONCLUSIONS: We concluded that inflammatory parameters, such as LRCP, SII and NLR, were associated with disease severity and could be used as potentially important risk factors for COVID-19 progression.

PMID:33887100 | DOI:10.1111/ijcp.14256

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Nevin Manimala Statistics

Impact of matrix support on older adults in primary care: randomized community trial

Rev Saude Publica. 2021 Apr 14;55:10. doi: 10.11606/s1518-8787.2021055002685. eCollection 2021.

ABSTRACT

OBJECTIVE: To analyze the effect of matrix support on health for older adults in primary care according to the dimensions of frailty measured with the Clinical-Functional Vulnerability Index-20 (IVCF-20).

METHODS: This is a randomized controlled community trial, developed in the Northern Minas Gerais state, Brazil, in 2018. Initially, the stratification of clinical and functional vulnerability of older adults supported by six Family Health Strategy teams occurred with the IVCF-20. Subsequently, three teams were drawn to receive matrix support for six months, and the others for control. In this intervention, face-to-face educational activities were developed for health teams. Descriptive statistics were performed, followed by bivariate analysis by Pearson’s chi-square test, to compare the variables of the IVCF-20 between the two moments (before and after the intervention), with a 5% significance level. Relative risks and respective 95% confidence intervals (95%CI) were estimated.

RESULTS: The groups were similar before intervention, and the effect of matrix actions was positive for most dimensions measured by IVCF-20 (instrumental daily living activity, cognition, mood, mobility, communication, and multiple comorbidities). At the end of the research, the percentage of frailty in the group assisted by professionals participating in matrix support was lower than that of the control group.

CONCLUSIONS: Matrix support actions, such as pedagogical attribution and horizontal care for health teams, have the potential to contribute to the articulation of models of care for older adults.

REBEC: registro BR-7b9xff.

PMID:33886949 | DOI:10.11606/s1518-8787.2021055002685

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Nevin Manimala Statistics

Evaluation of Electrical Burn Injuries in Iran: A 7 year retrospective study

J Burn Care Res. 2021 Apr 22:irab070. doi: 10.1093/jbcr/irab070. Online ahead of print.

ABSTRACT

Electrical burn injuries can cause devastating and debilitating morbidities and impairments for patients. This cross-sectional descriptive study was performed on electrical burn patients hospitalized from 2014 to 2019 to evaluate electrical burn injuries’ epidemiology and characteristics. A total number of 726 patients with the mean age of 31.17 years were evaluated for electrical burn injuries. Mean total burn surface area (TBSA) was 16.61 ± 12.56. Most victims were male (696 cases, 95.7%); and most patients did not have a constant job (n = 458, 63%). Most affected burn sites were hands (28.6%) and upper limbs (27.8%). A total number of 89 (12.2%) patients suffered amputations with the hand fingers (64 cases) as the most common site. Low voltage injuries were more common (n = 649 , 89%). Most incidents happened at the workplace (n =459 , 63%). Comparison of patients with high voltage and low voltage injuries showed significant correlations and statistical difference between these 2 groups regarding TBSA, mean hospital stays, escharectomy, fasciotomy, amputations, debridement, fracture and mortality rate (P = 0.001). Our observation revealed that electrical burn injuries are still significant causes of morbidity and mortality among trauma patients. In contrast to previous studies, low voltage injuries were more common than high voltage ones. We propose improvements in the manufacturing of electrical appliances; paying attention to safety measures will reduce thenumber of incidents. Moreover, training and education play important roles in reducing the number of incidents and mortality rates.

PMID:33886962 | DOI:10.1093/jbcr/irab070

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Nevin Manimala Statistics

Financial Considerations Associated With a Fourth Year of Residency Training in Family Medicine: Findings From the Length of Training Pilot Study

Fam Med. 2021 Apr;53(4):256-266. doi: 10.22454/FamMed.2021.406778.

ABSTRACT

BACKGROUND AND OBJECTIVES: The feasibility of funding an additional year of residency training is unknown, as are perspectives of residents regarding related financial considerations. We examined these issues in the Family Medicine Length of Training Pilot.

METHODS: Between 2013 and 2019, we collected data on matched 3-year and 4-year programs using annual surveys, focus groups, and in-person and telephone interviews. We analyzed survey quantitative data using descriptive statistics, independent samples t test, Fisher’s Exact Test and χ2. Qualitative analyses involved identifying emergent themes, defining them and presenting exemplars.

RESULTS: Postgraduate year (PGY)-4 residents in 4-year programs were more likely to moonlight to supplement their resident salaries compared to PGY-3 residents in three-year programs (41.6% vs 23.0%; P=.002), though their student debt load was similar. We found no differences in enrollment in loan repayment programs or pretax income. Programs’ descriptions of financing a fourth year as reported by the program director were limited and budget numbers could not be obtained. However, programs that required a fourth year typically reported extensive planning to determine how to fund the additional year. Programs with an optional fourth year were budget neutral because few residents chose to undertake an additional year of training. Resources needed for a required fourth year included resident salaries for the fourth year, one additional faculty, and one staff member to assist with more complex scheduling. Residents’ concerns about financial issues varied widely.

CONCLUSIONS: Adding a fourth year of training was financially feasible but details are local and programs could not be compared directly. For programs that had a required rather than optional fourth year much more financial planning was needed.

PMID:33887047 | DOI:10.22454/FamMed.2021.406778